TCDD Summarizes Sunset Commission
Staff Reports on State Health and
Human Services Agencies
The Texas Sunset Commission released staff reports recently with recommendations regarding the Department of Aging and Disability Services, the Department of Assistive and Rehabilitative Services, and the Department of State Health Services. The Sunset Commission is required to periodically review state agency functions to determine whether their functions are needed, and if so, how the agency can be managed more efficiently.
While the reports indicate that these agencies’ functions continue to be necessary, Sunset staff will not make their final recommendations regarding the future of each agency until work is completed on the review of the Health and Human Services Commission, due in October.
The recommendations summarized below are Sunset staff recommendations that will be presented to the Sunset Advisory Commission. The Sunset Advisory Commission is composed of five state senators, five representatives and two public members. The Commission will hold a public hearing to determine which recommendations to adopt for consideration by the Texas Legislature in 2015.
DADS oversees long-term care services and supports for more than a million Texans with disabilities. DADS administers a large number of programs and facilities and supervises many providers. Although DADS contracts for a substantial portion of its services, these contracts do not necessarily ease DADS’ administrative burden. DADS’ responsibility for management and monitoring of billions of dollars’ worth of contracts is spread across hundreds of staff throughout the agency. Thus, contract management was prominently featured as a critical function that requires uniform practices and greater oversight.
Among the issues identified by Sunset staff were: Texas continues to operate 13 State Supported Living Centers (SSLCs) despite declining enrollment, skyrocketing costs, and questionable quality of care; the need to transition people from SSLCs to the community and provide extra support to people with higher behavioral and medical support needs; the need to ensure adequate care in Day Habilitation standards; and Quality Reporting System improvements.
Noting declining enrollment, increasing costs and questionable quality, the Sunset staff made significant and clear recommendations regarding SSLC consolidation. Sunset staff made the following SSLC specific recommendations:
- Require DADS to close the Austin SSLC by August 31, 2017.
- Establish an SSLC Closure Commission to determine an additional five SSLCs to close.
- Require DADS to close the five SSLCs no later than August 31, 2022.
Sunset staff made rebalancing recommendations that would require DADS to invest savings from SSLC closure to “address the need for more consistent crisis support, adequate rates for people with more complex needs, [and] ensuring the safety of DADS’ clients in day habilitation facilities …”
The Texas Department of Aging and Disability Services (DADS) Quality Monitoring Program (QMP) (QRS) was also the subject of recommendations. It is the website used by the public to compare service providers. In addition to updating the QRS website for person-first, respectful language, Sunset staff made the following QRS specific recommendations:
- Require DADS to maintain a consumer information site on the quality of long-term care providers in Texas.
- Direct DADS to improve the quality and consistency of information available on the QRS for all providers.
DARS works with Texans with disabilities and families with children who have developmental disabilities to improve the quality of their lives and to enable their full participation in society. DARS’ activities fall into four main areas: employment, independent living, early childhood intervention, and disability determination services. Sunset staff chose to focus their report on the first two areas, employment and independent living, and did not make recommendations related to early childhood intervention or disability determination services.
DARS highlighted inefficiencies and duplication of services that lead to frustration for some DARS consumers. This is in part due to the consolidation of four separate agencies that took place 11 years ago to create DARS. The separate structures and missions of those agencies still exist as divisions within DARS today. As an example, vocational rehabilitation services are provided by two different divisions, one for people who are blind or have a vision disability and one for people with other disabilities. Consumers with multiple disabilities cannot receive necessary services from both divisions at the same time because DARS maintains an artificial wall between the two divisions.
The report noted that DARS’ enhanced coordination with employers and with state agencies in the workforce and education systems could improve employment outcomes for consumers. DARS could also better coordinate with local Centers on Independent Living (CILs), ensuring that DARS is not duplicating the services provided by the CILs and is providing appropriate referrals to the CILs.
Sunset staff made targeted recommendations to address these issues and to encourage accountable and effective management practices. Among the recommendations were the following:
- Require DARS to integrate administration, management, and oversight of the divisions for blind services and rehabilitation services to eliminate duplication and better serve consumers.
- Require DARS to build and maintain close coordination with the Texas workforce system and employers to increase job opportunities for people with disabilities.
- Require DARS to partner with the Texas Education Agency to develop a mechanism to target schools with the highest need for transition services, and to develop policies to ensure it provides a consistent, minimum level of service.
- Define DARS’ role in the provision of independent living services as supporting and monitoring the network of centers for independent living.
DSHS aims to improve health and well-being in Texas. To do so, DSHS performs a wide array of activities, including preventing and preparing for public health threats; contracting with providers and funding local health departments to improve community health by ensuring Texans have access to health services, prevention, and treatment; and promoting recovery for people with substance use disorders, mental health issues, and certain infectious diseases by funding services and providing inpatient hospitalization at the Texas Center for Infectious Disease, nine state mental health hospitals, the Waco Center for Youth, and the Rio Grande State Center.
Sunset concluded the breath and scope of authority of DSHS) leaves it a “jack of all trades and master of none.”
The Sunset report highlighted eight issue areas, none specific to children or adults with developmental disabilities or special health care needs. Among the recommendations were the following:
- Improve crisis capacity by improving communication and collaboration with the judiciary, ensuring hospitals are appropriately staffed by fall 2014, and adding capacity through community treatment alternatives while addressing gaps in tracking staffing, patient safety, and commitment type.
- Integrate mental health and substance abuse functions; focus funding equity of Local Mental Health Authorities on capacity; and in the next year implement outcomes-based measures and metrics for client outcomes, program effectiveness, and contractor performance.
- Eliminate eight advisory committees. Though the Drug Demand Reduction Advisory Committee and Local Area Network Advisory Committee (LMHAs) were recommended for elimination, their responsibilities would be assigned to the Council for Advising and Planning for the Prevention and Treatment of Mental and Substance Use Disorders (CAP).
Steps for Further Input
The Sunset Commission has scheduled a public hearing on these agencies for Tuesday and Wednesday, June 24 and 25. Public testimony will be taken on Wednesday, June 25. An agenda specifying the meeting time, location, and the order of agencies scheduled for discussion has yet to be posted. The Commission will meet again tentatively in August to make final decisions about recommendation to propose to the Legislature during the 84th Texas Legislature that begins January 13.
If you would like to provide input to the Sunset Commission regarding these or any other Sunset reports, there is a form available at sunset.texas.gov/input-form
- TCDD Self-Evaluation Report to the Sunset Advisory Commission (PDF, 87 pages, 712 KB)
- Department of Aging and Disability Services Sunset Commission Review Documents web page
- Department of Assistive and Rehabilitative Services Sunset Commission Review Documents web page
- Department of State Health Services Sunset Commission Review Documents web page
- Sunset Commission Public Input Forms for Agencies Under Review web page
- Sunset Commission Meetings web page